9 research outputs found
Parotid gland tumours: a clinicopathological review at the University of Witwatersrand
Background: Parotid tumours constitute a highly heterogeneous group. The pattern of parotid tumours in South Africa has not been extensively reported. Purpose: The aim of this study was to describe and analyse the clinical presentation and the histopathology of the parotid tumours in the Division of Otorhinolaryngology and Head and Neck Surgery at the academic hospitals of the University of Witwatersrand. Methods: We retrospectively reviewed the medical records of 71 patients who underwent parotid surgery for parotid tumours from January 2006 to December 2010. Data including age, gender, clinical signs, symptoms and histological findings were collected. Results: Of the 71 patients, 46 (64.78%) had benign tumours and 25 (35.22%) had malignant tumours. The most common benign tumour was pleomorphic adenoma (76.09%) and the most common malignant tumour was mucoepidermoid carcinoma (52%). The clinical findings did carry a significant importance in the malignant-benign differentiation especially the presence of pain (p=0.002) and facial weakness (p=0.003). Conclusion: Pleomorphic adenoma was the commonest benign parotid tumour and mucoepidermoid carcinoma was the most malignant tumour. The malignant-benign ratio was comparable to other African series. The presenting symptoms of pain and facial weakness were found to be strong indicators of malignant disease
Hospital acquired infections in pediatrics unit at Butare University Teaching Hospital (CHUB)
Background: Hospital acquired infection (HAI) also called nosocomial infection is an infection acquired in hospital or other healthcare facilities. HAIs are a major public health problem all over the world, but particularly in developing nations and they are among the major causes of death and increased morbidity among hospitalized patients. It was found that HAI in sub-Saharan Africa is the major cause of illness and death in children.Aim: The aim of this study was to provide knowledge on the prevalence of hospital acquired infection in pediatric unit of the University Teaching Hospital of Butare (Rwanda).Methods: Hospital acquired infections surveillance method and definition of infections described by CDC/NHSN were used.Results and conclusion: This study showed that the prevalence of HAI was very high (12.1 %) and the main bacteria causing NIs in pediatric unit were Kleblesiela pneumonia, followed by E. coli and Staphylococcus aureus. Low Respiratory HAIs were the most prevalent.Keywords: Prevalence, Hospital Acquired infection, Pediatric
malaria infection among schoolchildren in highland Rwanda
Background Plasmodium infection and malaria in school children are
increasingly recognized as a relevant public health problem, but data on
actual prevalence and health consequences are insufficient. The present study
from highland southern Rwanda aimed at estimating infection prevalence among
children attending school, at identifying associated factors and at assessing
the clinical consequences of these infections. Methods In a survey including
12 schools in the Huye district of Rwanda, 1089 children aged 6â10 years were
clinically and anthropometrically examined, malaria parasites were diagnosed
by microscopy and PCR, haemoglobin concentrations were measured, and socio-
economic and behavioural parameters as well as medical histories were
obtained. Results Upon examination, the vast majority of children was
asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4%
(Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent
predictors of infection included low altitude, higher age, preceding
antimalarial treatment, and absence of electricity or a bicycle in the
household. Plasmodium infection was associated with anaemia (mean haemoglobin
difference of â1.2 g/dL; 95% CI, â0.8 to â1.5 g/dL), fever, underweight,
clinically assessed malnutrition and histories of fever, tiredness, weakness,
poor appetite, abdominal pain, and vomiting. With the exception of
underweight, these conditions were also increased at submicroscopic infection.
Conclusion Malaria infection is frequent among children attending school in
southern highland Rwanda. Although seemingly asymptomatic in the vast majority
of cases, infection is associated with a number of non-specific symptoms in
the children´s histories, in addition to the impact on anaemia. This argues
for improved malaria surveillance and control activities among school
children
Flies from a tertiary hospital in Rwandacarry multidrug-resistant Gram-negativepathogens including extended-spectrumbeta-lactamase-producingE. colisequencetype 131
Multidrug-resistant gram-negative (MRGN) bacteria are a serious threat to global health. We used genomics tostudy MRGN obtained from houseflies in a tertiary Rwandan hospital. Our analysis revealed a high abundance ofdifferent MRGN includingE. colipathogenic lineage ST131 suggesting the important role of flies in disseminatinghighly virulent pathogens in clinical settings and beyon
Reduced efficacy of albendazole against Ascaris lumbricoides in Rwandan schoolchildren
Control of human soil-transmitted helminths (STHs) relies on preventive chemotherapy of schoolchildren applying the benzimidazoles (BZ) albendazole or mebendazole. Anthelmintic resistance (AR) is a common problem in nematodes of veterinary importance but for human STHs, information on drug efficacy is limited and routine monitoring is rarely implemented. Herein, the efficacy of single dose albendazole (400 mg) was evaluated in 12 schools in the Huye district of Rwanda where Ascaris is the predominant STH. Ascaris eggs were detected by wet mount microscopy and the Mini-FLOTAC method to assess cure rate (CR) and faecal egg count reduction (FECR). Blood and faecal samples were analysed for co-infections with Plasmodium sp. and Giardia duodenalis, respectively. Ascaris positive samples collected before and after treatment were analysed for putatively BZ-resistance associated β-tubulin gene single nucleotide polymorphisms. The overall CR was 69.9% by Mini-FLOTAC and 88.6% by wet mount microscopy. The FECR was 75.4% and the 95% calculated confidence intervals were 50.4â87.8% using sample variance, 55.4â88.8% by bootstrapping, and 75.0â75.7% applying a Markov Chain Monte Carlo Bayesian approach. FECR varied widely between 0 and 96.8% for individual schools. No putative BZ-resistance associated polymorphisms were found in the four Ascaris β-tubulin isotype genes examined. Since FECR
Circulation of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli of Pandemic Sequence Types 131, 648, and 410 Among Hospitalized Patients, Caregivers, and the Community in Rwanda
Multi-drug resistant (MDR), gram-negative Enterobacteriaceae, such as Escherichia coli (E. coli) limit therapeutic options and increase morbidity, mortality, and treatment costs worldwide. They pose a serious burden on healthcare systems, especially in developing countries like Rwanda. Several studies have shown the effects caused by the global spread of extended-spectrum beta-lactamase (ESBL)-producing E. coli. However, limited data is available on transmission dynamics of these pathogens and the mobile elements they carry in the context of clinical and community locations in Sub-Saharan Africa. Here, we examined 120 ESBL-producing E. coli strains from patients hospitalized in the University Teaching Hospital of Butare (Rwanda), their attending caregivers as well as associated community members and livestock. Based on whole-genome analysis, the genetic diversification and phylogenetics were assessed. Moreover, the content of carried plasmids was characterized and investigated for putative transmission among strains, and for their potential role as drivers for the spread of antibiotic resistance. We show that among the 30 different sequence types (ST) detected were the pandemic clonal lineages ST131, ST648 and ST410, which combine high-level antimicrobial resistance with virulence. In addition to the frequently found resistance genes blaCTXâMâ15, tet(34), and aph(6)-Id, we identified csg genes, which are required for curli fiber synthesis and thus biofilm formation. Numerous strains harbored multiple virulence-associated genes (VAGs) including pap (P fimbriae adhesion cluster), fim (type I fimbriae) and chu (Chu heme uptake system). Furthermore, we found phylogenetic relationships among strains from patients and their caregivers or related community members and animals, which indicates transmission of pathogens. Also, we demonstrated the presence and potential transfer of identical/similar ESBL-plasmids in different strains from the Rwandan setting and when compared to an external plasmid. This study highlights the circulation of clinically relevant, pathogenic ESBL-producing E. coli among patients, caregivers and the community in Rwanda. Combining antimicrobial resistance with virulence in addition to the putative exchange of mobile genetic elements among bacterial pathogens poses a significant risk around the world
Asymptomatic only at first sight: malaria infection among schoolchildren in highland Rwanda
Plasmodium infection and malaria in school children are increasingly recognized as a relevant public health problem, but data on actual prevalence and health consequences are insufficient. The present study from highland southern Rwanda aimed at estimating infection prevalence among children attending school, at identifying associated factors and at assessing the clinical consequences of these infections.; In a survey including 12 schools in the Huye district of Rwanda, 1089 children aged 6-10 years were clinically and anthropometrically examined, malaria parasites were diagnosed by microscopy and PCR, haemoglobin concentrations were measured, and socio-economic and behavioural parameters as well as medical histories were obtained.; Upon examination, the vast majority of children was asymptomatic (fever 2.7%). Plasmodium infection was detected in 22.4% (Plasmodium falciparum, 18.8%); 41% of these were submicroscopic. Independent predictors of infection included low altitude, higher age, preceding antimalarial treatment, and absence of electricity or a bicycle in the household. Plasmodium infection was associated with anaemia (mean haemoglobin difference of -1.2 g/dL; 95% CI, -0.8 to -1.5 g/dL), fever, underweight, clinically assessed malnutrition and histories of fever, tiredness, weakness, poor appetite, abdominal pain, and vomiting. With the exception of underweight, these conditions were also increased at submicroscopic infection.; Malaria infection is frequent among children attending school in southern highland Rwanda. Although seemingly asymptomatic in the vast majority of cases, infection is associated with a number of non-specific symptoms in the children´s histories, in addition to the impact on anaemia. This argues for improved malaria surveillance and control activities among school children
Comment on âThe optimal timing of post-treatment sampling for the assessment of anthelminthic drug efficacy against Ascaris infections in humansâ
A recent publication by Levecke et al. (Int. J. Parasitol, 2018, 8, 67â69) provides important insights into the kinetics of worm expulsion from humans following treatment with albendazole. This is an important aspect of determining the optimal time-point for post treatment sampling to examine anthelmintic drug efficacy. The authors conclude that for the determination of drug efficacy against Ascaris, samples should be taken not before day 14 and recommend a period between days 14 and 21. Using this recommendation, they conclude that previous data (KrĂźcken et al., 2017; Int. J. Parasitol, 7, 262â271) showing a reduction of egg shedding by 75.4% in schoolchildren in Rwanda and our conclusions from these data should be interpreted with caution. In reply to this, we would like to indicate that the very low efficacy of 0% in one school and 52â56% in three other schools, while the drug was fully efficient in other schools, cannot simply be explained by the time point of sampling. Moreover, there was no correlation between the sampling day and albendazole efficacy. We would also like to indicate that we very carefully interpreted our data and, for example, nowhere claimed that we found anthelmintic resistance. Rather, we stated that our data indicated that benzimidazole resistance may be suspected in the study population. We strongly agree that the data presented by Levecke et al. suggests that recommendations for efficacy testing of anthelmintic drugs should be revised.Peer Reviewe